342700471-8-24-2023-59-AS-KHOS-CV6P6U-20230829110254

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700471
Report Date: 08/24/2023
Date Signed: 08/24/2023 04:17:08 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/22/2023 and conducted by Evaluator Sarena Keosavang

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230822080832

FACILITY NAME:	COGIR OF STOCK RANCH		FACILITY NUMBER:	342700471
ADMINISTRATOR:	DAVID JR., RICKY		FACILITY TYPE:	740
ADDRESS:	7418 STOCK RANCH RD		TELEPHONE:	(916) 725-7418
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	99	CENSUS: 97	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:			TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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- Staff do not clean residents’ room.
- Resident room is malodorous.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced 08/24/2023 to conduct a complaint investigation for a complaint Community Care Licensing (CCL) received on 08/22/2023. LPA met with Executive Director (ED), Rick David, and explained the purpose of the visit.

LPA requested for pertinent documents relevant to the complaint such as, resident (R1) physician's report, emergency contact, admission agreement, appraisals, and assessments. During today's visit, LPA interviewed ED and a total of four (4) facility staff.

Allegation: Staff do not clean residents’ room.- Unsubstantiated.
According to complainant, for the last two months R1's room has had urine, old feces, old food, and trash on the floor. The house keepers have not gone into R1's room to clean because of the smell and the room is filthy.

Continue on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20230822080832

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: COGIR OF STOCK RANCH	FACILITY NUMBER: 342700471
	VISIT DATE: 08/24/2023

NARRATIVE

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On 8/23/20233, R1 moved out of the community. ED stated R1's bedroom was cleaned and provided pictures. LPA did not tour R1's bedroom due to the bedroom has been cleaned and was not in its original state. R1 is no longer living at the facility.

LPA received interview statement from a total of four (4) facility staff. Statements from all four (4) staff were consistent. R1 bedroom was a "mess" and refused cleaning services. Interview statement received from S2 indicated, housekeeper is scheduled to clean residents rooms every once a week; however, housekeeper has been cleaning R1's room twice a week. LPA received interview statement from R1's responsible party (RP). RP stated the allegation is not true and that R1 refuses services from staff.

Allegation: Resident room is malodorous. - Unsubstantiated.
LPA received interview statement from a total of four (4) facility staff. Interview statement from three (3) staff indicated, R1's room is not malodorous and does not smell like urine or feces. Interview statement from S4 indicated, R1's room smells like urine and feces depending on which week it is, but housekeeper has not missed a cleaning day. Interview statement received from R1's RP indicated, R1 refuses staff to assist with toileting and showers. RP and facility head nurse had a meeting and a plan in place for R1. Head nurse suggest for R1 to participate by letting staff provide services and assist but R1 refuses.

Based on department’s investigation as stated above, the preponderance of evidence standards has not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and report provided.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena Keosavang	TELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

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